Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF June 30, 2017 | Archived Issues

More Education Needed on Women, Heart Disease

Bairey Merz co

Women and their physicians are largely uneducated when it comes to females and heart disease, putting women’s health and lives at greater risk, a new study shows. The study, published in the Journal of the American College of Cardiology, shows that 45 percent of U.S. women are unaware heart disease is the No. 1 killer of women. Even though the majority reported having a routine physical or wellness exam in the past year, only 40 percent reported having a heart health assessment by their healthcare provider.

» Read more

New Patient Safety Curriculum Being Rolled Out

Cedars-Sinai is rolling out a new patient safety curriculum that standardizes responses to adverse events and helps front-line leaders implement changes to prevent recurrences. Front-line leaders are attending a two-hour educational session that combines lectures and interactive training tailored to each clinical area. The session is gradually being introduced to departmental teams throughout Cedars-Sinai.

» Read more

Cancer Survivors Honored for Courage, Resilience

Cancer Survivors Day amber horn

More than 500 cancer survivors, their loved ones and Cedars-Sinai staff turned out for the 31st Annual Cancer Survivors Day luncheon June 16 at the Sofitel Los Angeles at Beverly Hills. "This isn't just a luncheon. It's a really important day that validates and celebrates all that our patients have been through, and applauds their resiliency," said Arash Asher, MD, director of the Cancer Rehabilitation and Survivorship program at the Samuel Oschin Comprehensive Cancer Institute.

» Read more

Platform for Vancomycin Measurements to Change

The Department of Pathology and Laboratory Medicine will be changing platforms for vancomycin measurement beginning Tuesday, Aug. 1. Vancomycin is being moved from a Beckman AU680 platform to redundant Roche P Modules in order to provide backup of instrumentation when maintenance issues arise.

» Read more

Core Labs Changing Ketone Testing in July

The Core laboratories in the Department of Pathology and Laboratory Medicine will be switching ketone testing to Precision Xceed Pro Monitor instruments from Abbott Diabetes Care Ltd. beginning Tuesday, July 25.

» Read more

Circle of Friends Honorees for May

CoF

The Circle of Friends program honored 206 people in May. Circle of Friends allows grateful patients to make a donation in honor of the physicians, nurses, caregivers and others who have made a difference during their time at Cedars-Sinai.

» Read more

Cedars-Sinai Launches Blog

Employees are invited to explore the new Cedars-Sinai blog that gives employees, patients, their families and the community a relatable and shareable experience of Cedars-Sinai. Blog content highlights health and wellness tips from leading experts, provides insights into the latest research at Cedars-Sinai and showcases the human side of healthcare.

» Read more

Summer Is Coming, and So Are Fireworks

Celebrate Independence Day at the Hollywood Bowl with fireworks and music by the Hollywood Bowl Orchestra and a special musical guest, Grammy-winning a cappella group Pentatonix. The event on Monday, July 3, is open to Cedars-Sinai physicians and their immediate family members. Cost is $140 per adult and $70 per child 3-11 years of age.

» Read more

CS-Link Tip: Medication Reconciliation

cs-link logo

Medication reconciliation is important, and CS-Link™ can help. The care team needs an accurate and current medication list, which appears in patient settings. To see notes added, click the “Med Notes” box. To learn more, an e-learning lesson has been created.

» Read more

More Education Needed on Women, Heart Disease

Bairey Merz 200px

C. Noel Bairey Merz, MD

Women and their physicians are largely uneducated when it comes to females and heart disease, putting women's health and lives at greater risk, a new study shows.

The study, published in the Journal of the American College of Cardiology, shows that 45 percent of U.S. women are unaware heart disease is the No. 1 killer of women. Even though the majority reported having a routine physical or wellness exam in the past year, only 40 percent reported having a heart health assessment by their healthcare provider.

As for physicians, only 39 percent of primary care physicians surveyed for the study indicated that heart disease is a top health concern for their female patients, and only 35 percent bring up the topic during exams with new patients.

"We clearly have a lot of work to do to make women aware that heart disease is a bigger threat to their health than all types of cancer combined," said C. Noel Bairey Merz, MD, director of the Cedars-Sinai Barbra Streisand Women's Heart Center.

Patients aren't the only ones in need of heart health education, said Bairey Merz, who led the study funded by the Women's Heart Alliance, a nonprofit organization exclusively dedicated to women's heart health. Bairey Merz serves as a scientific adviser to the group.

"We also need to work with primary care physicians to make sure they understand how to assess and treat women with heart disease, which often presents with different symptoms than does heart disease in men," added Bairey Merz.

Some of the data from the study was presented earlier this year at the American College of Cardiology Scientific Sessions. The data came from a survey of 1,011 U.S. women ages 25-60 and a separate survey of 200 physicians. The margin of error is plus or minus 3.4 percentage points.

Results show:

  • Only 22 percent of primary care physicians and 42 percent of cardiologists felt well prepared to assess heart disease in women.
  • A majority of women reported having a routine physical or wellness exam, yet only 40 percent reported having a heart health assessment.
  • Sixty-three percent of women admitted they sometimes put off going to the physician, and 45 percent said they canceled or postponed a doctor appointment because they wanted to lose weight.
  • While 74 percent reported having one or more heart disease risk factors, only 16 percent were informed by their physician that they were at risk.
  • Twenty-six percent of women said having heart disease would be an embarrassment because others would assume the woman was not eating healthy or exercising.

New Patient Safety Curriculum Being Rolled Out

Cedars-Sinai is rolling out a new patient safety curriculum that standardizes responses to adverse events and helps front-line leaders implement changes to prevent recurrences.

As part of the new curriculum, front-line leaders attend a two-hour educational session that combines lectures and interactive training tailored to each clinical area. The session is gradually being introduced to departmental teams throughout Cedars-Sinai.

Staff from the Newborn Nursery, the Neonatal Intensive Care Unit and the Labor and Delivery Department were the first group to receive the training in March. Laboratory Services had two scheduled sessions, and 8OR staff completed training in May.

The new curriculum builds on Cedars-Sinai’s patient safety processes, focusing on leadership’s role in driving a culture of safety through a standardized approach. Pilot areas were identified by the operational vice presidents as part of a directive from the Executive Safety Group, co-chaired by Mark Gavens, executive vice president of Hospital Operations and chief operating officer, and Michael Langberg, MD, senior vice president of Medical Affairs and chief medical officer.

"A need was identified by staff," said Edward G. Seferian, MD, chief patient safety officer. "They want tools so they will know how to respond to an event when it happens on their unit. That was really what the curriculum was designed to do."

A central component of the new patient safety course is an immediate risk-mitigation checklist that guides leaders through a standardized process of follow-up. It helps pinpoint, immediately after an adverse medical event, where a breakdown occurred and whether the service that was delivered is safe for the next patient. The program also helps leaders provide support to staff in the emotional aftermath of an event.

Another program aim is to foster a work environment in which staff members feel comfortable speaking up and sharing their candid recollections of events. People need to feel safe in order to call attention to processes and behaviors that could place patients at risk, said Marle Shelton-Hoff, director of affiliate quality relations, who spearheaded the development of the new patient safety curriculum in collaboration with nursing leadership and Sagar Sable, patient safety program manger.

The program has been well received.

"We received positive feedback from the pilot attendees and are looking forward to rolling the course out to all clinical areas," Shelton-Hoff said.

Charles Simmons Jr., MD, chair of the Department of Pediatrics and director of the Division of Neonatology, has taken the training, and said the program provides practical tools for managing difficult circumstances. Following the training, Simmons’ team quickly put the program to the test.

"We were able to utilize [the curriculum] within 48 hours of when the training had concluded," Simmons said. "We were quite pleased with how readily the materials and conceptual framework could be applied to the situation."

If you have questions, contact Shelton-Hoff at 310-423-2059 or marle.shelton-hoff@cshs.org.

Cancer Survivors Honored for Courage, Resilience

Cancer Survivor’s Day amber horn 480px

Amber Horn, who survived spinal cord cancer, spoke at the Cancer Survivors Day luncheon June 16.

Tears, cheers and laughter animated the 31st Annual Cancer Survivors Day luncheon on June 16 at the Sofitel Los Angeles at Beverly Hills. Two banquet rooms were needed to accommodate more than 500 survivors, their friends and family, and Cedars-Sinai staff who attended.

The invitation-only event is open to cancer survivors from the Samuel Oschin Comprehensive Cancer Institute, including its affiliates.

"This isn't just a luncheon. It's a really important day that validates and celebrates all that our patients have been through, and applauds their resiliency," said Arash Asher, MD, director of the Cancer Rehabilitation and Survivorship program at the cancer institute.

Cancer survivors’ stories — including those of speakers Amber Horn and Shelly Gossman — inspired the audience.

"Amber and Shelly weren't pollyannaish about their difficult journeys, but they also made it clear that cancer doesn't have to take away your joy or your ability to embrace life," Asher said.

cancer survivor terri crumpton 240px

Terri Crumpton, diagnosed with breast cancer in June 2015, celebrated her triumph over cancer at the luncheon.

Horn, 38, spoke about being diagnosed with spinal cord cancer seven years ago. A successful Hollywood casting director, she likened her medical journey to a comedy/horror movie.

"There was a monster inside my spinal cord that would likely leave me paralyzed," she said. That prognosis played out, but not permanently. After spending a year in a wheelchair, the Texas native regained her mobility.

The comedy tag, she explained, "reflects the laughter I deployed to get through some of the toughest moments," including excruciating post-surgical pain, grueling radiation treatments and chemotherapy.

"I learned how strong I am," Horn said. “I learned that anything is possible, and you can't stop believing." One word summed up her greatest takeaway: "gratitude."

Also at the podium was Gossman, a comedian whose credits include popular television shows like Saturday Night Live and Raising Hope, and The Second City comedy club in Chicago. She riffed on the root of her current happiness.

"I'm 39 and can't wait to turn 40," she said. "A lot of my friends are sad about getting older, but I couldn't be happier. Cancer makes me appreciate every day, every wrinkle, every person who cuts me off in traffic. Honking reminds me I'm alive!"

She has faced cancer twice, so that outcome was far from certain.

At 23, the Wisconsin native was diagnosed with non-Hodgkin lymphoma. A five-year battle ensued that Gossman won.

While working the main stage at The Second City, she was asked by Gilda's Club Chicago — a cancer-support organization — to teach patients improvisational comedy techniques as a means of managing stress. Gossman accepted and found a new calling.

"It was one of the best things I'd ever done in my life," she said.

Television writing gigs landed Gossman in Los Angeles, but at age 36 an unexpected plot twist arose: triple negative breast cancer. "I started chemo on my first wedding anniversary," she said, fighting back tears.

Gossman prevailed over what she jokingly dubbed "Cancer Part Two: Electric Boogaloo." She recently started writing for A.P. Bio, an NBC sitcom premiering this season, and has returned to teaching improv as a cancer-coping tool.

In closing, Robert Figlin, MD, deputy director of the cancer institute's integrated oncology service line, told guests, although Cedars-Sinai already is Southern California's largest cancer-care provider, it's committed to growing its cancer-care network.

"I thank each of you for sharing part of your day with us," Figlin said. “And congratulations to all on your inspiring journeys."

cancer survivor stephanie lovick 480px

Stephanie Lovick of Marina del Rey was at the luncheon to celebrate completing breast cancer treatment.

Platform for Vancomycin Measurements to Change

The Department of Pathology and Laboratory Medicine will be changing platforms for vancomycin measurement beginning Tuesday, Aug. 1.

Vancomycin is being moved from a Beckman AU680 platform to redundant Roche P Modules in order to provide backup of instrumentation when maintenance issues arise. In addition, the recommended therapeutic intervals are being updated so they will be in line with the most recent guidelines for efficacy.

Also, please note that the validated specimen type will change from lithium heparin plasma to serum. The toxic value, the point where providers are contacted, will remain at 20 mg/L. (This change is temporary as the transition to new Abbott platforms occurs around September.)


Vancomycin Therapeutic Interval
Beckman Assay (current)
PLASMA (Lithium Heparin & EDTA) and SERUM
Roche Assay (new)
SERUM ONLY
Trough 5-10 mg/L

10-20 mg/L

General therapeutic goals for trough vancomycin are as follows: 10-15 mcg/mL for uncomplicated infections and 15-20 mcg/mL for more complicated infections.

References: Cedars-Sinai antiomicrobial stewardship committee Vancomycin Procedure and American Journal of Health-System Pharmacy January 2009,66 (1) 82-98.

Peak 30-40 mg/L 25-40 mg/L

Evaluating trough vancomycin levels are the most accurate and practical method for monitoring efficacy. Despite a range being provided, monitoring of peak vancomycin levels is often not clinically indicated.


If you have questions, please contact Kimia Sobhani, PhD, at kimia.sobhani@cshs.org.

Core Labs Changing Ketone Testing in July

The Core laboratories in the Department of Pathology and Laboratory Medicine will be switching ketone testing to Precision Xceed Pro Monitor instruments from Abbott Diabetes Care Ltd. beginning Tuesday, July 25.

Specifically, beta-hydroxybutyrate (BHB), the dominant ketone body produced in fasting states and diabetic ketoacidosis, will be quantitatively measured in whole blood. Measurement of BHB will replace qualitative testing for aceotoacetate via Acetest™ tablets (in serum and urine).

Manufacture of Acetest Reagent has been discontinued. The change offers in improvement in the detection of ketoacidosis due to the quantitative nature of the replacement test and the fact that BHB is the dominant ketone (BHB/acetoacetate ratio is approximately 3:1 to 7:1 in severe ketotic states).

Additionally, acetoacetate is relatively rapidly converted to beta-hydroxybutyrate, which means Acetest is subject to false negative results.

Only whole blood samples will be acceptable on the new BHB assay. The reference cutoff for BHB: <0.6 mol/L

If you have questions, please contact Kimia Sobhani, PhD, at kimia.sobhani@cshs.org.

Circle of Friends Honorees for May

The Circle of Friends program honored 206 people in May.

Circle of Friends allows grateful patients to make a donation in honor of the physicians, nurses, caregivers and others who have made a difference during their time at Cedars-Sinai. When a gift is made, the person being honored receives a custom lapel pin and a letter of acknowledgement.

See more information about the program and a list of past honorees.

  • Daniel C. Allison, MD, MBA, FACS
  • Neel Anand, MD
  • Monique F. Araya, MD
  • M. William Audeh, MD
  • David A. Austin, MD
  • Babak Azarbal, MD
  • Esther Baik, MD
  • C. Noel Bairey Merz, MD, FACC, FAHA
  • Babak R. Bamshad, MD
  • Terry Barnes
  • Stephanie D. Battle
  • Bruce Baumgarten, MD
  • Ami Ben-Artzi, MD
  • Peiman Berdjis, MD
  • Satinder J. Bhatia, MD
  • Anton J. Bilchik, MD
  • Keith L. Black, MD
  • Matthew H. Bui, MD, PhD
  • Miguel A. Burch, MD
  • C. Michele J. Burnison, MD
  • Ilana Cass, MD
  • Dorrie Chang, MD
  • Kirk Y. Chang, MD
  • Piyaporn Chantravat, RN
  • Jennifer M. Chen
  • Jeffrey Chung, MD, FAAN
  • Stephen R. Corday, MD
  • Kenneth A. Corre, MD
  • Alice C. Cruz, MD
  • Lawrence S. Czer, MD
  • Catherine M. Dang, MD, FACS
  • Ryan DellaMaggiora, MD
  • Candace M. DeSarro
  • Alice R. Dick, MD
  • Suhail Dohad, MD
  • Noam Z. Drazin, MD
  • Michael T. Duffy, MD
  • Julie A. Dunhill, MD
  • Mary El-Masry, MD
  • Diana C. Erazo
  • Brandon Esenther, MD
  • Fardad Esmailian, MD
  • Richard Essner, MD, FACS
  • Azita Far, MD
  • Sharmayne Farrior, BSN, RN, CPN
  • Robert A. Figlin, MD, FACP
  • Rebecca Fisher
  • Mario E. Flores
  • Charles A. Forscher, MD
  • Hernilda C. Fortenberry
  • Richard T. Francia
  • Arnold S. Friedman, MD
  • Stuart Friedman, MD
  • Srinivas Gaddam, MD
  • Steven S. Galen, MD, FACC
  • Larisa Gallo
  • Eli S. Gang, MD
  • Dael Geft, MD
  • Avner G. Gereboff, MD
  • Armando E. Giuliano, MD, FACS, FRCSEd
  • Jay E. Gladstein, MD
  • Richard N. Gold, MD
  • Neil J. Goldberg, MD
  • David B. Golden, MD
  • Alyssa T. Gong
  • Richard E. Gould, MD
  • Violette G. Gray, MD
  • Abe Green, MD
  • Paul B. Hackmeyer, MD
  • Solomon I. Hamburg, MD, PhD
  • Michele A. Hamilton, MD
  • Michael D. Harris, MD
  • Emmanuel E. Hernandez
  • Allen S. Ho, MD
  • David M. Hoffman, MD
  • Rowena M. Ira, CNA
  • Waguih W. IsHak, MD
  • Laith H. Jamil, MD
  • Jay A. Jensen, MD
  • Renee A. Johnson, RN
  • Estrella M. Jordan, RN
  • David Y. Josephson, MD
  • Neel R. Joshi, MD
  • Marshall L. Kadner, MD
  • Arthur M. Kahn, MD
  • Sheila Kahwaty, PA-C
  • Beth Y. Karlan, MD
  • Brenda L. Kearney, RN
  • Elnaz Kermani
  • Ali Khoynezhad, MD, PhD, FACS, FACC
  • Michelle M. Kittleson, MD, PhD
  • Charles F. Kivowitz, MD
  • Dennette L. Klute Evans, RN
  • Jon A. Kobashigawa, MD
  • Gordon F. Kolodny
  • David A. Kulber, MD, FACS
  • Stuart H. Kuschner, MD
  • Sandra M. Labat, RT
  • Shouri Lahiri, MD
  • Naileen R. Lal, BSN, RN, PHN
  • Daisy C. Lengkong
  • Ronald S. Leuchter, MD
  • Michael M. Levine, MD
  • Andrew J. Li, MD
  • Michael C. Lill, MD
  • Gene Liu, MD
  • Simon K. Lo, MD, FACP
  • Joan E. Lutz, MN, RN
  • Rajendra Makkar, MD
  • Adam N. Mamelak, MD, FACS
  • Jon V. Manacmul,
  • William J. Mandel, MD
  • Harumi O. Mankarios, RN, OCN
  • Kalinda S. Marshall, CNII
  • Ruchi Mathur, MD, FRCP(C)
  • David N. Matsumura, MD
  • Philomena McAndrew, MD
  • Brianna McCarthy
  • Gil Y. Melmed, MD, MS
  • Amin J. Mirhadi, MD
  • Monica M. Mita, MD, MDSc
  • Cyrus K. Mody, MD
  • Hattie M. Munn
  • Abirami Muthukumaran, MD
  • Ronald B. Natale, MD
  • Ryan E. Nestler, BSN, RN
  • Alan C. Newman, DDS
  • Christopher S. Ng, MD
  • Roy D. Nini, MD
  • Nicholas N. Nissen, MD
  • Mazen Noureddin, MD
  • Adrian G. Ostrzega, MD
  • Ronald L. Paquette, MD
  • Marilou S. Paraiso
  • Bindi A. Patel, PA
  • Jignesh K. Patel, MD, PhD
  • Brad Penenberg, MD
  • Alice Peng, MD
  • Tiffany G. Perry, MD
  • Alistair Phillips, MD
  • Edward H. Phillips, MD, FACS
  • Anupama R. Pillai, NP
  • Mark Pimentel, MD, FRCP(C)
  • Linda Piponniau, BSN, RN
  • Edwin M. Posadas, MD
  • Levon Qasabian, MD
  • Maria A. Quinones
  • David S. Ramin, MD
  • Danny Ramzy, MD, PhD, FRCSC, FACC
  • Alexandre Rasouli, MD
  • Edward Ray
  • Luisa S. Revilla
  • Madison F. Richardson, MD
  • Bobbie J. Rimel, MD
  • Miranda Ripper, BSN, RN, RN-C
  • Joseph L. Robinson, MD
  • Barry E. Rosenbloom, MD
  • Paula J. Rubin
  • Jeremy D. Rudnick, MD
  • Rahnana Sachs, MD
  • Vivian L. Salle, RN
  • Gregory P. Sarna, MD
  • Brenda J. Selby
  • Prediman K. Shah, MD
  • Michael M. Shehata, MD
  • Takahiro Shiota, MD, FACC, FAHA
  • Vivian N. Shirvani, MD
  • Shant Shirvanian
  • Khawar M. Siddique, MD
  • Matthew M. Siedhoff, MD
  • Robert J. Siegel, MD
  • Allan W. Silberman, MD, PhD, FACS
  • Amanuel Sima, MD, FAASM
  • Steven M. Simons, MD, FACP, FCCP
  • Siddharth Singh, MD
  • Melinda Sobel
  • Richard Sokolov, MD
  • Stephanie Sorak, RN, OCN
  • Andrew I. Spitzer, MD
  • Theodore N. Stein, MD
  • Jerrold H. Steiner, MD, FACS
  • Daniel J. Stone, MD, MPH, MBA
  • Carey B. Strom, MD
  • Andrea D. Sutherland, RN
  • Clive N. Svendsen, PhD
  • Jane W. Swanson, PhD
  • Charles D. Swerdlow, MD
  • Gaurav Syal, MD
  • Steven N. Sykes, MD
  • Lillian Szydlo, MD
  • Michele Tagliati, MD, FAAN
  • David B. Thordarson, MD
  • Alfredo Trento, MD, FACS
  • Gregory Tsushima, MD, FACS
  • Alex R. Turnipseed
  • Marina Vaysburd, MD
  • Angela W. Velleca, BSN, RN, CCTC
  • Robert A. Vescio, MD
  • Erica T. Wang, MD
  • Joanna L. Wilson, RN-BC, OCN
  • Philip A. Yalowitz, MD
  • Clement C. Yang, MD
  • Sina Yang
  • Payam R. Yashar, MD, FACC
  • Phillip C. Zakowski, MD
  • Raymond Zimmer, MD

Cedars-Sinai Launches Blog

Employees are invited to explore the new Cedars-Sinai blog that gives employees, patients, their families and the community a relatable and shareable experience of Cedars-Sinai.

Blog content highlights health and wellness tips from leading experts, provides insights into the latest research at Cedars-Sinai, and showcases the human side of healthcare. The featured stories, of which many feature employees and programs, help celebrate the traits that make Cedars-Sinai a world-class healthcare institution.

The blog is intended to serve as a bridge — a way to keep patients and the community engaged when they don’t have an immediate need for care.

For more information, visit the new Cedars-Sinai blog.

Cedars Sinai Blog

Summer Is Coming, and So Are Fireworks

Hollywood Bowl 2015

The Hollywood Bowl

Celebrate Independence Day at the Hollywood Bowl with fireworks and music by the Hollywood Bowl Orchestra and a special musical guest, Grammy-winning a cappella group Pentatonix.

The event on Monday, July 3, is open to Cedars-Sinai physicians and their immediate family members. Cost is $140 per adult and $70 per child 3-11 years of age.

Parking passes also are available. Valet is $50, lower terrace is $21.

To reserve a place, contact Cheryl Verne at 310-423-2681 or cheryl.verne@cshs.org.

CS-Link Tip: Medication Reconciliation

Medication reconciliation is important, and CS-Link™ can help. The care team needs an accurate and current medication list, which appears in patient settings.

To see notes added, click the "Med Notes" box. To learn more, an e-learning lesson has been created. (You will be directed to HealthStream; click "Enroll" to view.)

HealthStream also now offers Physician Efficiency Training modules for continuing medical education credit. There are 22 modules that last 15 minutes each. They include topics such as "In Basket Quick Actions," "Smart Blocks in Progress Notes" and "SmartList Editor."

To take advantage, log into HealthStream and search the catalog using keywords: PET CME. Select the module you want and to view, then click "Enroll."